| NPI | 1134584519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODRIGUE TERTUS Authorized Official 954-416-1781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107169) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2015-12-29 |