| NPI | 1407734031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN MARTIN PETTY Owner 919-648-0618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-08-22 |