| NPI | 1477649887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELDAGAE CHISA President Owner 248-647-5015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301022545) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 4301032103) |
| 332900000X Non-Pharmacy Dispensing Site (Licence: MI 4301022545) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-03-13 |