| NPI | 1790210235 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01066) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT003958) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |