| NPI | 1053128694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DOUGLAS MILLER Vice President 972-906-8103 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2024-12-17 |