| NPI | 1770009995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DESOUSA Owner 352-585-5581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2019-01-10 |