| NPI | 1518543172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS E MARTENS Credentialing Specialist 512-523-4878 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2021-04-14 |