| NPI | 1790430072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HERIBERTO BOLANOS Certified Surgical First Assistant 512-644-1931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-02-15 |