| NPI | 1205112208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE EHANDRY RIVERO Surgical Assistant 561-531-7914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |