| NPI | 1386160513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOD NORTHRUP Medical Director, Owner 904-466-1197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL OS7217) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2022-07-21 |