| NPI | 1902930209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN KOESTER M.D. 405-216-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: OK 18783) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |