| NPI | 1043956915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARRET DAVIS Secretary 432-640-2414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-09-26 |