| NPI | 1871733592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS BRIAN GILLEN Owner 832-646-5176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03999) |
| Enumeration Date | 2009-02-21 |
| Last Update Date | 2009-02-21 |