| NPI | 1316267404 |
|---|---|
| Former Name | TIFFANY SOPHIA OVERSTREET |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 075202) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101021534) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 75202) | |
| 208D00000X General Practice (Licence: GA 75202) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2024-05-09 |