| NPI | 1780163378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BROOKE MORELAND Licensed Surgical Assistant 936-444-7071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX SA00639) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2022-03-30 |