| NPI | 1013300904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAJEAN RACHEL MOSELEY-LARUE CEO 817-800-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX TXPA01480) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |