| NPI | 1205270824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS CHARLES WHEELER Medical Director 407-599-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME73845) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2021-03-22 |