| NPI | 1609118645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELSON ANTHONY GUZMAN Manager 239-206-3328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105161) |
| Enumeration Date | 2013-03-16 |
| Last Update Date | 2013-03-16 |