| NPI | 1053008318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES AARON BONANNO Sole Proprietor 954-590-0556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-12-05 |