| NPI | 1982065843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WV AT001347) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH AT.004242) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2016-03-18 |