| NPI | 1578077871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OFFICE CREDENTIALIN Credentialing Officer 832-623-5583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J3003) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2023-03-30 |