NPI | 1598889123 |
---|---|
Other Name | SHELBY RAEGENE BLACK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO 246ZS0400X) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |