| NPI | 1891719423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP JOHN BOSHA President 940-484-1887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: TX L9632) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |