| NPI | 1225703788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUBINA YELENA Provider 844-373-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2022-08-29 |