| NPI | 1780072306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY AT1175) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY 1116380) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2022-05-09 |