NPI | 1730401399 |
---|---|
Former Name | XAVION SADE CARTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A00368) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 1545) |
Enumeration Date | 2010-02-24 |
Last Update Date | 2018-03-17 |