| NPI | 1104032176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WARREN ANDERSON President 407-872-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME46655) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME 7956) |
| 363A00000X Physician Assistant (Licence: FL PA9100990) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |