| NPI | 1396223905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRECK WHEELOCK Manager 562-846-8191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11268) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2018-08-06 |