NPI | 1033497425 |
---|---|
Former Name | LACEY BURRELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WY 211) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: SD 0410) |
Enumeration Date | 2011-08-02 |
Last Update Date | 2018-12-20 |