| NPI | 1598148645 |
|---|---|
| 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 | 2015-07-08 |
| Last Update Date | 2015-07-08 |