| NPI | 1811321524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY J BYRNE President 469-401-2386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2014-01-15 |