| NPI | 1730696956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDALL EDWARD CARLL Owner/Manager 469-693-0165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: TX M8573) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL TRN6843) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2019-06-11 |