| NPI | 1538521596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KY DAU Physician Assistant 813-960-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9109120) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-10-17 |