| NPI | 1225689144 |
|---|---|
| Doing Business As | KSJGQ |
| Entity Type | Organization |
| Authorized Contact | LAWRENCE IDIGBE Nurse Practitioner 214-636-0418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2020-07-29 |