| NPI | 1245316165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD WELLIVER Physician Sole Proprietor 561-667-8369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME92061) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |