| NPI | 1295290823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BRADLEY DRAKE Owner 210-541-9001 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2022-06-15 |