| NPI | 1750898920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORBE LUIS BASULTO CEO 786-556-8819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX 17-657) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2018-01-09 |