| NPI | 1891104725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY A MORELLO Physician Assistant 754-264-2407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107748) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME39636) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2016-09-18 |