| NPI | 1760434187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HOLDREN CAO 570-271-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 363L00000X Nurse Practitioner | |
| 213E00000X Podiatrist (Licence: PA SC004396L) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-06-27 |