| NPI | 1902871395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OR ATAT10158311) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 67-000925) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ID AT-488) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-05-04 |