| NPI | 1598176554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ATSUKO KODAMA Owner 267-538-5045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: PA MD440883) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD440883) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-08-22 |