| NPI | 1063097137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMMON LARSEN Co Owner 970-667-3116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-26 |