| NPI | 1861432395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT FERGUSON Billing/Credentialing Mgr. 813-938-5693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 212419) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-12-30 |