| NPI | 1629466644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2020-11-19 |