| NPI | 1255791125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DEULOFEUT Provider/Owner 325-670-7671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: TX M3518) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2016-03-04 |