| NPI | 1447953351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH HAYNES Credentialing Manager 726-208-3118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2024-06-12 |