| NPI | 1225114218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY B. SHOVERS President 414-545-4646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WI 30083) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |