| NPI | 1598146557 |
|---|---|
| Former Name | COURTNEY RUE CHAMPAGNE |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2019014137) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2015017799) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-06-11 |