| NPI | 1619483443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL B RILEY Licensed Surgical Assistant 832-559-3870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2017-12-15 |