| NPI | 1063759314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE WEISS Practice Administrator 941-552-8341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME34530) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2016-12-01 |