| NPI | 1750779310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1619) |
| Additional Taxonomies | 247200000X (Licence: WI 14-1116) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-02-17 |