| NPI | 1245017185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY BULGER President 855-727-2251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2023-10-03 |