| NPI | 1265995781 |
|---|---|
| Former Name | MICHELLE JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125.075376) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036167925) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-05-22 |