| NPI | 1720459258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GODBOLD Officer 469-401-2386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |