NPI | 1255619854 |
---|---|
Former Name | TAMARA MARIE JETTE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD453089) |
Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MT200298) |
207T00000X Neurological Surgery (Licence: PA MD453089) | |
2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD453089) | |
Enumeration Date | 2011-07-30 |
Last Update Date | 2023-12-01 |