| NPI | 1457404097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUMMITTE DALE WILSON Md 716-648-2770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 134469) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |