| NPI | 1073253506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE ALYSE STOCKTON Licensed Surgical Assistant 361-793-9044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2022-04-26 |