| NPI | 1528386588 |
|---|---|
| Former Name | CHARLENE MARIE BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A136169) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2012027909) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2016-02-01 |