| NPI | 1609135755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SAINNOVAL Member 863-623-4486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME112305) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 112305) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2022-07-21 |