| NPI | 1033776323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN M KEAN Authorized Official 910-530-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2023-07-31 |