| NPI | 1275066227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY LILLIAN AGUERO L Icensed Surgical Assistant 210-639-3353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2018-10-13 |