| NPI | 1336508449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R THOMSEN Owner 863-294-3109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2016-08-17 |