| NPI | 1205106812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM C JERNBERG Owner 214-712-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |