| NPI | 1609239847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SHANE PETRIE President 336-403-5331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD438908) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD438908) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2016-06-06 |