| NPI | 1750416608 |
|---|---|
| Former Name | BROOKE SHANNON GRANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 46788) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 40450) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-07-21 |