| NPI | 1932295219 |
|---|---|
| Former Name | MARIE F MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX H9540) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX H9540) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-08-09 |