| NPI | 1952732646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN A LILLEGARD Practice Manager 281-364-9509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX J1040) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E0920) |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2013-12-05 |