| NPI | 1457423782 |
|---|---|
| Former Name | SHANNON MARIE RADEKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MN 37730) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 49115) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2017-04-27 |