| NPI | 1760194443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE AYANDIBU Medical Director 940-239-9160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology |
| Additional Taxonomies | 207N00000X Dermatology |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2023-04-10 |