| NPI | 1760958862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MI 1170085801) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |