| NPI | 1639917974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RURIC ANDERSON Md 848-336-1789 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207RS0010X Internal Medicine, Sports Medicine | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-07-19 |