| NPI | 1427203348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PAUL WIDICK Sole Mbr 321-799-9797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: FL ME0061454) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2008-11-19 |