| NPI | 1114403276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL LOPEZ Provider 407-480-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 18324) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2023-12-16 |