| NPI | 1063796571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS HERNANDEZ Physician Assistant 318-812-4663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA A10630rx) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2011-10-03 |