| NPI | 1316489156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRYLEE OTIMEYE EJUWA Owner 817-251-0550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2020-06-30 |