| NPI | 1770731598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUITH T SIMON COO 281-438-8755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 213E00000X Podiatrist | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |