Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 4, 2006
License(s)
PA9100207 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 848508 | Pembroke Pines, FL 33084-0508 | |
| LOCATION | 1613 HARRISON PKWY | Sunrise, FL 33323-2853 | 954-838-2371 |
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.