| NPI | 1740333244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY WOLAN Controller 561-687-5753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-10-23 |