| NPI | 1649870783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER FORMUSOH Owner Of Entity 817-546-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2024-04-26 |