| NPI | 1003050352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD H DEHAVEN Sole Proprietor 321-622-8943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME035779) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |