| NPI | 1083686091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIUS ANTOINNE WILSON Owner President 713-450-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX J2845) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2017-07-20 |