| NPI | 1942098983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNA LAROQUE Director, Client Experience 210-714-5647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |