| NPI | 1194938118 |
|---|---|
| Former Name | MEGGAN R BANTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2007021690) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 0432913) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-10-21 |