| NPI | 1477997799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEE KOMOR Office Manager 941-923-1809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME0039577) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ARNP9221877) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-10-23 |