| NPI | 1164500336 |
|---|---|
| Former Name | CYNTHIA JO BLALOCK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: OK R0037159) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-02-20 |