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 |