| NPI | 1902872039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JOSEPH SHEAR Staff Officer 703-693-5601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 2261) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2020-08-22 |