| NPI | 1235591777 |
|---|---|
| Former Name | STACEY MARIE MOHAMMADIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 52441) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4141) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2019-04-24 |