| NPI | 1265661839 |
|---|---|
| Former Name | TRACY BRAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WA MD60863073) |
| Additional Taxonomies | 2085R0001X (Licence: IL 125.056642) |
| 2085R0001X (Licence: OH 35-122218) | |
| Enumeration Date | 2009-07-05 |
| Last Update Date | 2021-05-05 |