| NPI | 1710238597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LIEURANCE Administrator 941-330-8553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine Sports Medicine (Licence: FL ME30555) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: FL CH7524) |
| 171100000X Acupuncturist (Licence: FL AP2975) | |
| 208D00000X General Practice (Licence: FL OS5165) | |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |