| NPI | 1417128380 |
|---|---|
| Former Name | ALEXIS SMITH SHIVELY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 34.011434) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS016619) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2022-07-21 |