| NPI | 1649542150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUENBY LEA ERICKSON Owner 210-274-5520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2006001518) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2006001518) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |