| NPI | 1457696056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L GIBSON Credentialing Specialist 210-494-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD.203514) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-13 |