NPI | 1104189745 |
---|---|
Former Name | MEREDITH LYNN GRAVES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 03317) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101020115) |
2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-00848) | |
Enumeration Date | 2012-06-19 |
Last Update Date | 2023-09-21 |