| NPI | 1093084568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACEK JOHN STASIKOWSKI Medical Doctor 817-926-8002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX E5623) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |