| NPI | 1841638632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OR AT-AT-10178305) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WY 030) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2017-03-29 |