| NPI | 1689893224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKOLAS JOHN COLLUCCI President 386-586-5344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202K00000X (Licence: FL ME39243) |
| Additional Taxonomies | 202K00000X (Licence: FL OS4153) |
| 207VH0002X Obstetrics & Gynecology, Hospice and Palliative Medicine (Licence: FL ME39243) | |
| 207Q00000X Family Medicine (Licence: FL OS4153) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2013-02-11 |