| NPI | 1588958615 |
|---|---|
| Former Name | MARISA RACHEL LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C2-0024617) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 951) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS024408) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2025-07-02 |