| NPI | 1467560896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN MICHAEL JANKE Owner 321-615-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9102122) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2010-12-08 |