| NPI | 1760743751 |
|---|---|
| Former Name | CRYSTAL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101261806) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL34777) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2019-01-03 |