| NPI | 1134870595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA BAE CASSELMAN Pnp, Owner 602-499-2362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-01-17 |