| NPI | 1720687270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 019869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH030874) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY 019869) | |
| Enumeration Date | 2020-10-25 |
| Last Update Date | 2020-11-02 |