| NPI | 1790406189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON J COAKLEY Owner 843-449-0453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| 207NS0135X Dermatology Procedural Dermatology | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2022-09-06 |