| NPI | 1407915929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANJUL D DERASARI Medical Director 813-933-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME54111) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2013-12-19 |