| NPI | 1255907622 |
|---|---|
| Former Name | CAMILLE ALYSSA BULTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0104352) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MD D0104352) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2025-07-17 |