| NPI | 1073295283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN G PORTOGUES Physician Assistant 954-856-3438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |