| NPI | 1164604724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM MARTIN MALONE Director 407-782-2205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL L07000110264) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |