| NPI | 1821048828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA M ROPER Credentialing Manager 843-936-7189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-08-12 |