| NPI | 1376072181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMENIC IACOVONE President 772-631-1563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL os10791) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL OS10791) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-07-21 |