| NPI | 1568716645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL NURIEL Authorized Official / Shareholder 941-870-0199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS7691) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2015-06-24 |