| NPI | 1104683457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARCHESE Credentialing Manager 214-205-4995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-04 |