| NPI | 1902089253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE J GRAVEL President 954-592-4292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA3729) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2007-12-10 |