| NPI | 1548672686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN WILDER Director Of Sports Medicine 410-704-3606 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD 24645) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2015-06-15 |