| NPI | 1477107910 |
|---|---|
| Professional Name | LOOK BACK REJUVENATION |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 062761-23) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2021-05-06 |