| NPI | 1962873901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT.004295) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001829A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001217) | |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2015-10-16 |