| NPI | 1942966015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000050620) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 763680) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2022-05-11 |