| NPI | 1942881677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE MARTINEZ Practice Administrator 417-622-0293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2024-12-24 |