| NPI | 1932667037 |
|---|---|
| Former Name | AMBER MICHELLE PORTWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002940) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |