NPI | 1992036651 |
---|---|
Former Name | SERENA LYNN MCCLAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D70319) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC 9557275) |
Enumeration Date | 2010-01-20 |
Last Update Date | 2012-05-08 |