| NPI | 1144950486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HOGAN Owner 936-295-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-06-10 |