NPI | 1730539404 |
---|---|
Former Name | JESSICA SONDERUP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NE 35445) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 7665) |
207N00000X Dermatology (Licence: IA MD-46322) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: IA MD-46322) | |
Enumeration Date | 2016-06-14 |
Last Update Date | 2025-01-14 |