| NPI | 1154832277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOJO DEGROOT Administrator 602-466-9664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: AZ 4105) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 4105) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |