| NPI | 1588141170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES AARON HENLEY Owner 918-409-3497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 4195) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2024-04-17 |