| NPI | 1811300502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR FRAGOSO Manager 210-859-5438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00305) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |