| NPI | 1093687261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HAGAN Mso 210-500-6449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2025-09-18 |
| Last Update Date | 2025-09-18 |