| NPI | 1902457591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WV AT001635) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL5241) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |