| NPI | 1417442898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCY A ODUEYUNGBO Authorized Official 906-362-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-10-31 |