| NPI | 1902992340 |
|---|---|
| Former Name | LISA L WILLACKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35088540) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 47728) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-06-12 |