| NPI | 1790173805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrolllment Lead 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2020-11-20 |