| NPI | 1114427739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FIELEKE Credentialing Manager 816-287-1528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2024-09-27 |