| NPI | 1003109059 |
|---|---|
| Former Name | AMANDA JOY IVERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 61224) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD454550) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-04-06 |