NPI | 1821636564 |
---|---|
Entity Type | Organization |
Authorized Contact | LIET LE Owner/Provider 832-777-7559 |
Organization Subpart ? | No |
Primary Taxonomy | 207N00000X Dermatology |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-12-12 |
Last Update Date | 2019-12-12 |