| NPI | 1598167009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORBE BASULTO Lsa 768-556-8818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00474) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2018-06-20 |