| NPI | 1841679461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH ROSS Credentialing 239-732-1133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME0061940) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2016-03-16 |