| NPI | 1972345312 |
|---|---|
| Former Name | LISA MICHELLE WILCOXSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL6505) |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-06-07 |