NPI | 1790348472 |
---|---|
Former Name | LAURA JOY KOOISTRA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: MN 73044) |
Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01092483A) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IN 01092483A) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-17 |
Last Update Date | 2024-03-08 |