| NPI | 1811722523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT LOUIS LEAVITT Owner 407-875-2080 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-03 |