| NPI | 1568076180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELSON E. VELAZQUEZ Sole Owner 304-252-2673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |