| NPI | 1710367313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT1225) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY 1116690) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |