| NPI | 1023171105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN T. SMITH Sole Member 540-777-1711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102050098) |
| Additional Taxonomies | 202K00000X (Licence: VA 0102050098) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2011-02-02 |