| NPI | 1871040733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT7721) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01113) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 24-01113) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2019-11-19 |