| NPI | 1790166494 |
|---|---|
| Former Name | JACEY ANE LOBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: IN 01086554A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107377) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-10-12 |