| NPI | 1568009058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN KAMINSKI Manager 903-939-7792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2023-09-07 |