| NPI | 1164859229 |
|---|---|
| Doing Business As | LIFEWAY DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | ANTHONY PHAN NIKKO President 713-960-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX K5639) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2013-10-03 |