| NPI | 1184173403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVOUNE PETRIE Director 703-938-1421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101231928) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: VA 0101231928) |
| 208D00000X General Practice (Licence: VA 0101231928) | |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |