| NPI | 1265092043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE ZIMMER Credentialing 956-627-0741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207R00000X Internal Medicine | |
| 2251S0007X Physical Therapist, Sports | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-06-14 |