| NPI | 1568833010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA STEVENS Physician Assistant 302-998-5272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00843) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |