| NPI | 1780128892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 2553-39) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: WI 2553-39) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2024-10-18 |