| NPI | 1942968524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY HEINRICH Manager 239-799-7057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2022-11-15 |