| NPI | 1770896235 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60281755) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: WA MD60281755) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT190483) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2017-04-12 |