| NPI | 1649909375 |
|---|---|
| Former Name | BLAKE RYAN PRUITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 8080) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-10-25 |