| NPI | 1922593060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE DAWN NEIDER Owner 833-688-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VT 0420013164) |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2020-11-23 |