| NPI | 1205037454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FIVENSON President 734-222-9630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI DF404817) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2013-12-02 |