| NPI | 1740684463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2013030176) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 001165) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096004831) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2023-03-13 |