| NPI | 1265862668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOOTHBY Owner 817-529-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2013-11-21 |