| 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 |