| NPI | 1649717620 |
|---|---|
| Former Name | STEPHANIE SACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO LUQ402) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2017-01-27 |