| NPI | 1760816573 |
|---|---|
| Former Name | KAREN KICZEK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 2000013464) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2017-05-04 |