| NPI | 1184147449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MENDOZA Do 443-255-5130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-03-07 |