| NPI | 1093860199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAFWAN SHAMS President 386-586-1810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME036504) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME036504) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |