| NPI | 1093873226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENT SMITH BRISTER President 772-713-7231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA3641) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-10-04 |