| NPI | 1487122099 |
|---|---|
| Former Name | CANDICE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: KY SA297) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |