| NPI | 1780241729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHEAL L BOOKHARDT Owner 321-229-8868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2024-03-04 |