NPI | 1376075812 |
---|---|
Former Name | JESSICA SHARON MOUNESSA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0066767) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2017-04-03 |
Last Update Date | 2021-08-21 |