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 |