| NPI | 1063631380 |
|---|---|
| Former Name | SHANNON DALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2010028604) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 43050) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.093769) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-11-04 |