| NPI | 1083339147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEIKO SARGENT Head Of Clinical Operations 855-920-2377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2024-09-25 |