| NPI | 1821773300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL SOLIS Manager 956-605-6420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |