| NPI | 1801144522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA BATCH Administrator 210-822-8326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2014-09-11 |