Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
May 5, 2009
License(s)
25MP00216900 (NJ), PA9107122 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 3434 HANCOCK BRIDGE PKWY STE 301 | N Fort Myers, FL 33903-7094 | 877-856-3774 |
| LOCATION | 3326 DEL PRADO BLVD S STE 8 | Cape Coral, FL 33904-7299 | 239-540-0081 |
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.