| NPI | 1598417404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISHA AMEY Provider Enrollment Specialist 484-526-2538 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-01-21 |