| NPI | 1669035408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M STRAIGHT Medical Director 210-569-1215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 202K00000X |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-03-07 |