| NPI | 1720486566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 2192-39) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: MN 2603) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2022-08-11 |