| NPI | 1265751879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARUN K PENUKONDA President 239-574-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0062366) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: FL ME0062366) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2011-12-16 |