| NPI | 1669518668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIAN BROOK ANDERSON Owner, Physician 307-734-5864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WY 7168A) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2009-02-27 |