| NPI | 1679155543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICK ANTONIO GRANA Medical Director 813-868-1659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |