| NPI | 1043873771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL MELVILLE Member 817-600-8725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2022-12-02 |