NPI | 1770041428 |
---|---|
Former Name | KAILYN BROOKE OVERCASH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-2948) |
Enumeration Date | 2019-03-12 |
Last Update Date | 2019-03-12 |