| NPI | 1992048748 |
|---|---|
| Former Name | SAMANTHA STALEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301114289) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2020-04-22 |