| NPI | 1821419011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDA LEA NICOSIA Owner 903-566-6816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00471) |
| Enumeration Date | 2013-12-15 |
| Last Update Date | 2015-11-18 |