| 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 |