| NPI | 1114355518 |
|---|---|
| Former Name | MARY DIETLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: OK 122922) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2013-10-22 |