NPI | 1669787131 |
---|---|
Former Name | KIMBERLY ANN WERNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: TX S0590) |
Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101250207) |
207N00000X Dermatology (Licence: FL ME135731) | |
208D00000X General Practice (Licence: VA 0101250207) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2010-08-09 |
Last Update Date | 2023-12-28 |