| NPI | 1912092693 |
|---|---|
| Former Name | SUSAN ELISE JAHNKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD21378) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00037941) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |