| NPI | 1619343985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER A BLOOM Owner 214-206-1445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-08-21 |