| NPI | 1407040710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN D FORMAN Physician 813-890-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME95483) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2008-06-04 |