| NPI | 1306383294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BIJU M LUKOSE CEO 469-546-5304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M7387) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX M7387) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2023-07-17 |