| NPI | 1992045272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NITRA H WELCH CFO 386-256-1444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2025-08-18 |