| NPI | 1871864264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN SCOTT SANDERS Managing Member 772-778-7782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 87851) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 87851) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |