| NPI | 1881384915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY SCOTT YOUSE Chief Medical Officer 217-729-7650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |