| NPI | 1275925869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MARIE OWENS Managing Owner 210-541-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207ZD0900X Pathology, Dermatopathology | |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2022-04-19 |