| NPI | 1750175501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOT ACKERMAN Authorized Official 904-880-5522 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2085R0001X |
| Additional Taxonomies | 208800000X Urology |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-04-07 |