| NPI | 1790169548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILIANA OMAWUMI EZECHIGBO Np 832-212-4739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128425) |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2015-07-11 |