| NPI | 1801219944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD J GROSS Owner 407-333-3040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0074351) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME74351) |
| Enumeration Date | 2014-01-25 |
| Last Update Date | 2014-08-05 |