| NPI | 1659357655 |
|---|---|
| Former Name | MARY JO THERESA WYSOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS005976L) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 043603) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2016-06-30 |