| NPI | 1093511339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATACHA WILLIAMS Billing/Credentialing Director 757-608-9255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-19 |