| NPI | 1134698103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKOLAS E POULOS President 719-505-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2025-03-13 |