| NPI | 1578073276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SHERRY BALL Owner 716-982-4165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 174400000X Specialist |
| 207NS0135X Dermatology, Procedural Dermatology | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-10-07 |
| Last Update Date | 2017-10-07 |