| NPI | 1053702431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOUZON BASS Agent 972-367-4845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2021-12-17 |