| NPI | 1790043008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHINI DEWKINANDAN Credentialing Specialist 954-822-7328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 111629) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |