| NPI | 1841707767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OK 843) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2015003670) |
| Enumeration Date | 2017-12-30 |
| Last Update Date | 2017-12-30 |