| NPI | 1780023192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRESCOTT BENTON HOLLAND Surgical First Assistant 469-684-1578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-07-16 |