NPI | 1821484486 |
---|---|
Former Name | MELISSA M STALOWSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 0493) |
Enumeration Date | 2015-04-10 |
Last Update Date | 2015-11-30 |