| NPI | 1790348472 |
|---|---|
| Former Name | LAURA JOY KOOISTRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01092483A) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IN 01092483A) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-07-15 |