| NPI | 1053573303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES FREDERICK WILSON Chairman 301-384-7687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 644) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2008-08-21 |