| NPI | 1669638904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DOUGLAS RUNK Chief Operating Manager 941-923-7318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 3599) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2011-07-01 |