| NPI | 1225629215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN JAMES SUPIK President / Founder 443-562-7814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-01 |