| NPI | 1023353125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH A KOSTER Registered Agent 352-592-4696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL pa9102477) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2012-12-01 |