Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 25, 2023
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5750 CENTRE AVE | Pittsburgh, PA 15206-3721 | |
| LOCATION | 2595 TAMPA RD | Palm Harbor, FL 34684-3152 | 727-712-1567 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.