| NPI | 1306142146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE A NICKSON Owner 972-547-0047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2022-05-05 |