| NPI | 1184950784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB MAYBERRY Owner 281-463-6309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX C080326A) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2014-08-19 |