NPI | 1144625245 |
---|---|
Former Name | RAYLENE LOOMIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: MA 112783) |
Enumeration Date | 2014-10-31 |
Last Update Date | 2019-11-08 |