| NPI | 1457887093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY BULLARD Owner 817-355-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |