NPI | 1922533090 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003095) |
Additional Taxonomies | 172V00000X Community Health Worker (Licence: KY AT1409) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003468) | |
Enumeration Date | 2017-04-26 |
Last Update Date | 2020-02-14 |