NPI | 1922748961 |
---|---|
Former Name | LACEY SOLOMON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: IL 125.080041) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2022-03-29 |
Last Update Date | 2023-07-12 |