| NPI | 1518848969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY PAUL EWBANK Owner 407-449-2645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2025-09-11 |