| NPI | 1083000509 |
|---|---|
| Former Name | TIFFANY ELIZABETH SUE GOADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-10 |