| NPI | 1902187701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE THOMAS SEROYER President 817-419-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N1887) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-09-07 |