| NPI | 1366410920 |
|---|---|
| Former Name | SUSAN SCHROEDER ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA08824100) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 40371) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-08-01 |