| NPI | 1043363666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MICHAEL WEAVER President 979-575-7435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2013-04-08 |