| NPI | 1912755083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 126800000X Dental Assistant |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-13 |