| NPI | 1164165296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILYA LIM Co Owner 941-499-0199 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QX0200X Clinic/Center Oncology |
| Additional Taxonomies | 207NP0225X Dermatology Pediatric Dermatology |
| 207NS0135X Dermatology Procedural Dermatology | |
| 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery | |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2023-10-10 |