| NPI | 1639754021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURESH KUMAR Member 214-618-1676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084S0010X Psychiatry & Neurology Sports Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 293D00000X Physiological Laboratory | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-03-17 |