| NPI | 1336498344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS J RE Managing Member 407-791-1543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9103254) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2013-04-11 |