| NPI | 1619286267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID E NOVAK Administrator 941-870-2057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |