| NPI | 1770859357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 000815) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2011016897) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VA 0126002493) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2018-09-29 |