| NPI | 1952538076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON B PAYSEUR Owner 469-277-2701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX M0858) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-11-11 |