| NPI | 1508500638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD TAYLOR LANDRUM Owner 817-793-0513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-09-15 |