| NPI | 1194370536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP MARK NEAL Manager, Member 985-868-1810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2019-08-02 |