| NPI | 1740490499 |
|---|---|
| Former Name | LAURA MAE WHITE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 11993) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD436885) |
| 208600000X Surgery (Licence: OH 57-008625) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-05 |