| NPI | 1003478157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALILAH Q CLARKE Doctor 817-662-7044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2024-11-04 |