NPI | 1659119998 |
---|---|
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 |