| NPI | 1407930332 |
|---|---|
| Former Name | STACEY MARIE LOOK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WI 45886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 45885-020) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2012-06-20 |