| NPI | 1861588592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA KAY LOWERY Credentialing Manager 469-930-3077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101027073) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-10-23 |