| NPI | 1093273781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA PROVIDENZA Admistrator 817-614-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2019-03-12 |