| NPI | 1770941254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 11557284-4810) |
| Additional Taxonomies | 171W00000X Contractor (Licence: GA AT002244) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2021-07-21 |