| NPI | 1972759918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH WILSON Owner 954-432-7860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9101757) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2008-09-19 |