| NPI | 1538340039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE M. GARDNER Registered Agent 407-733-5464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA3289) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2009-03-03 |