| NPI | 1356520407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS SOCKWELL President 941-914-6610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL P04000127074) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2012-06-22 |