| NPI | 1316075013 |
|---|---|
| Former Legal Business Name | DR MARK D LARSON |
| Entity Type | Organization |
| Authorized Contact | MARK D LARSON Owner 409-833-0193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX h8192) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2008-06-09 |