| NPI | 1760202873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILL ALVAREZ Credentialing Coordinator 844-384-2476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-18 |