| NPI | 1922238666 |
|---|---|
| Former Name | STEPHANIE JOY INGHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101018273) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-011401) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2019-10-16 |