| NPI | 1225424740 |
|---|---|
| Former Name | LISA MARIE LOPEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS13514) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-08-25 |