| NPI | 1962099630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.005333) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: IL 22-0418) |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2023-07-31 |