| NPI | 1811878952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA BLAKELY Practice Manager 214-445-6959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-12-08 |