| NPI | 1639202294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD A. KOTZ Owner 843-766-9868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 24039) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 24039) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2011-01-18 |