NPI | 1104032176 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHAEL WARREN ANDERSON President 407-872-1110 |
Organization Subpart ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9100990) |
Additional Taxonomies | 174400000X Specialist (Licence: FL ME46655) |
174400000X Specialist (Licence: FL ME 7956) | |
Enumeration Date | 2007-05-15 |
Last Update Date | 2025-09-11 |