| NPI | 1730578774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN O BRAVO Provider/Owner 863-398-8362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2016-08-01 |