| NPI | 1912496985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YONAH KNUCKLES Administrator 817-201-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AG03180006) |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2018-05-05 |