| NPI | 1942713052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH GRUMMER Owner 239-595-5124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2014-02302) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2014-02302) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2023-08-07 |