| NPI | 1740752211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY MCAULIFF Owner 469-931-0684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2021-09-22 |