| NPI | 1730539404 |
|---|---|
| Former Name | JESSICA SONDERUP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-46322) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7665) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IA MD-46322) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-07-21 |