| NPI | 1669125241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN DEAN MEDECK Owner/Physician's Assistant 605-381-6082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2022-02-02 |