| NPI | 1972560753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER LEE HAHN Chief Financial Officer 304-822-6614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 15226) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 15226) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2016-04-20 |