| NPI | 1750077889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IKECHUKWU OKOLOCHA Owner 469-289-2660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |