| NPI | 1811232820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL E VIDERS Owner 508-847-6616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 249077) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 247239) |
| Enumeration Date | 2012-12-02 |
| Last Update Date | 2012-12-02 |