NPI | 1871639757 |
---|---|
Entity Type | Organization |
Authorized Contact | DARREN WAYNE LACKAN Owner 682-225-1157 |
Organization Subpart ? | No |
Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX L6481) |
Enumeration Date | 2007-01-29 |
Last Update Date | 2025-09-23 |