| NPI | 1417644873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN DAVID GREGORY Chief Accession Medical Waiver Div 210-652-9205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |