| NPI | 1952687014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LI MA Member 352-212-5567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |