| NPI | 1568691764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WISSAM NOUBANI Owner 817-472-7601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA03902) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2009-07-08 |