| NPI | 1548441652 |
|---|---|
| Former Name | LAURA JEAN FORTMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2007-11-16 |