| NPI | 1871151621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: BOC366719) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2255A2300X) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |