| NPI | 1043509086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH D FAGBOHUN Administrator 281-948-8342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 733191) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2012-08-29 |