| NPI | 1225755101 |
|---|---|
| Former Name | DUSTINE ODLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA 61337407) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 22720) |
| 208600000X Surgery (Licence: NV 1617A) | |
| 208600000X Surgery (Licence: TX 15868) | |
| 208600000X Surgery (Licence: AZ 8161) | |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-10-21 |