| NPI | 1053684803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN CHAMBERLAIN Member 817-808-5180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX TX PA03501) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |