| NPI | 1104269307 |
|---|---|
| Former Name | TISHA ROYSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020029634) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 329433-01) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD15110) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2025-03-05 |