| NPI | 1457065781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL MABATAH Director 972-400-5450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-11 |