| NPI | 1508177064 |
|---|---|
| Former Name | TRACY MCCOY |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2020027287) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS015021) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-09-14 |