| NPI | 1740618974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKI M RENTA Credentialing 954-382-2930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107526) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2013-10-25 |