| NPI | 1962805036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN KODAE President 832-877-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 132700000X Dietary Manager | |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| 225100000X Physical Therapist | |
| 225700000X Massage Therapist | |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2014-10-03 |