| NPI | 1013669126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GOOLDY Authorized Official 803-462-5440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-20 |