| NPI | 1942259197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN B BETTERIDGE Manager 253-227-5208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: UT 2948311205) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: UT 58953691205) |
| Enumeration Date | 2006-05-07 |
| Last Update Date | 2020-08-22 |