| NPI | 1063632040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUY P LARSEN Director 239-334-3545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0026178) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0026178) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-08-22 |