| NPI | 1285414888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD BENNINGHOFF Owner 512-203-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |