NPI | 1366611311 |
---|---|
Former Name | SUSUN BELLEW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NV DO1612) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 005520) |
Enumeration Date | 2008-02-25 |
Last Update Date | 2016-03-15 |