| NPI | 1003139718 |
|---|---|
| Former Name | LIESL BREANN SHOCKLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TX R3333) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R3333) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2024-02-01 |