NPI | 1720405087 |
---|---|
Former Name | KATHERINE ALYSSA NOLAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME148243) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA A152052) |
Enumeration Date | 2014-03-25 |
Last Update Date | 2021-07-22 |