| NPI | 1528589918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM TUCKER, JR. President 214-165-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX AP127091) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2022-07-21 |