| NPI | 1760635429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDI LAROCHE Mso Credentialing Coordinator 321-449-4168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME0076509) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2010-08-06 |