| NPI | 1568810935 |
|---|---|
| Former Name | CANDACE MARIE BROUSSARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 1017761) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01084188A) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2024-03-13 |