| NPI | 1174702989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER A DONELAN Owner 813-972-1229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0035372) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2016-03-22 |