| NPI | 1134632474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA MICHAEL HENRY Owner 949-212-3425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: FL ME114798) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2023-05-19 |