| NPI | 1215932520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELENA ORAVETZ Credentialing 904-384-2240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2024-06-21 |