| NPI | 1184169393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW KENICK Physician Assistant 954-298-1218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA3593) |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2016-12-23 |