| NPI | 1417177270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK ANTHONY BERGER Practice Manager 979-297-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX M5052) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2008-06-23 |