| NPI | 1972109148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY M KJELDGAARD Owner / President 817-283-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |