| NPI | 1316496458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON POTTER Owner 214-540-1420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2016-09-30 |