| NPI | 1255678355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PATRICK DESOUZA President 386-774-5755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0062917) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2014-04-29 |