| NPI | 1326206301 |
|---|---|
| Former Name | MANJU TRACY CHACKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A121539) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 246191-1) |
| 207N00000X Dermatology (Licence: CA FD2807052) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2017-04-13 |