| NPI | 1205036662 |
|---|---|
| Former Name | LISA MARIE NIEBERGALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 45448) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: CO 45448) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2022-09-09 |