| NPI | 1114427739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEDA GERSTL Credentialing Manager 904-302-6983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-02-21 |