| NPI | 1093972820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE H FREDRICKSON CFO 954-355-4088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |