| NPI | 1568883536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER SEAN GODDARD Mgrm 305-367-1176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL os10979) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL 1037) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2022-02-16 |