| NPI | 1508424169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNA LAROQUE Director Of Client Experience 210-598-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2022-07-07 |