| NPI | 1265455703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301064919) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: MI 4301064919) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-08-01 |