| NPI | 1003644840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAIZ Owner/ Np 239-877-8522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207N00000X Dermatology |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2024-11-02 |