| NPI | 1114489945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED MARK NOVICE Owner 248-932-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2019-04-01 |