NPI | 1912170838 |
---|---|
Entity Type | Organization |
Authorized Contact | AMY DEHAVEN Credentialing Specialist 210-615-9990 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5020) |
Enumeration Date | 2008-04-11 |
Last Update Date | 2008-04-11 |