| NPI | 1699157958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN KALOUST Manager Member 813-228-6334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine Obesity Medicine (Licence: SC 20034883) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2015-06-23 |