| NPI | 1992206155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYETTE BOUCHER President 239-948-1222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-02-23 |