| NPI | 1790348472 |
|---|---|
| Former Name | LAURA JOY KOOISTRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 1023399) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 1023399) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-07-02 |