| NPI | 1811273790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL R PRENTICE Owner 352-597-4686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |