| NPI | 1972391357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER TERENTEV Chief Executive Officer 386-523-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |