| NPI | 1699821298 |
|---|---|
| Former Name | MISTY DAWN MANUEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 025987) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 239109) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-03-10 |