| NPI | 1710620885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEL N BOSWELL Credentialing Manager 813-538-7880 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-18 |