| NPI | 1821569138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA I LEE Credentialing Manager 702-798-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2018-12-13 |
| Last Update Date | 2018-12-18 |