| NPI | 1962853754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601001803) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 010702101) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-09-06 |