| NPI | 1720200124 |
|---|---|
| Former Name | AMY NICOLE GEBAUER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: MO 2010014073) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: KS 33229) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-09-06 |