| NPI | 1558774224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA WOJTECZKO Practice Operations Manager 321-841-1869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PAT9107947) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |