| NPI | 1336291038 |
|---|---|
| Former Name | STACEY RAE BLACK ARMSTRONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 64805) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 45984) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AZ 45984) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-03-01 |