| NPI | 1114290624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DMITRY TUDER Authorized Official 210-598-5605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2022-01-05 |