| NPI | 1053969287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN WILLIAM AHERN Provider/Owner 979-314-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2020-04-03 |