| NPI | 1972983104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BIJU LUKOSE CEO 979-358-0435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX M7387) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M7387) |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2017-03-14 |