| NPI | 1063782621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHIBA K TAREEN Owner 734-546-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 54002) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2020-12-17 |