| NPI | 1649664251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PONO MCDOWELL Vice President/Co Owner 321-877-4732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: FL POR 134) |
| Additional Taxonomies | 222Z00000X (Licence: FL POR 134) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2021-09-17 |