| NPI | 1306089800 |
|---|---|
| Former Name | JACQUELINE NICOLE FLANDRY FUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 070111) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 70111) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-06-17 |