| NPI | 1699220152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA MICHELLE GALLARDO Administrator 832-875-2253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2017-03-06 |