| NPI | 1992853154 |
|---|---|
| Former Name | HEATHER WOODWORTH WICKLESS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P8628) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036.116991) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2018-01-30 |