| NPI | 1790121689 |
|---|---|
| Former Name | LACEY BETH ELWYN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2018-01570) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 276541) |
| 207N00000X Dermatology (Licence: FL OS14737) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2022-07-21 |