| NPI | 1477907517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON AARON WALTER DAVID Member 657-999-5679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |