| NPI | 1699294751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WAYNE ROBERTSON Manager 281-900-3144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00487) |
| Enumeration Date | 2017-09-10 |
| Last Update Date | 2017-09-10 |