| NPI | 1538171616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN KACAL Administrator 432-617-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA03371) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-08-22 |