| NPI | 1962948067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI R563298115437) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MI R563298115437) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |