| NPI | 1831331396 |
|---|---|
| Former Name | JACLYNN LOUISE EDWARDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD042906) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35097526) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2016-06-13 |