NPI | 1316380694 |
---|---|
Former Name | MEREDITH LYNN WALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: TN 58455) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AL MD.48544) |
207N00000X Dermatology (Licence: IL 036.165930) | |
207N00000X Dermatology (Licence: CA A146514) | |
Enumeration Date | 2013-04-16 |
Last Update Date | 2025-08-08 |