| NPI | 1710396064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 3609) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: RI AT00357) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2014-08-11 |