| NPI | 1992035695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN MACINNIS Owner 352-350-5230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME100399) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2018-03-17 |