| NPI | 1962851329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OK AT795) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO AT2009010050) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-07-22 |