| NPI | 1043955404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MARENO Owner 972-417-1936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-04-30 |
| Last Update Date | 2023-01-05 |