| NPI | 1467846956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WAGNER Owner 305-987-4443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101701) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |