| NPI | 1083825947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE J BASS President 916-739-1505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA C34793) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G36407) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A55877) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2014-12-11 |