| NPI | 1063834646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON S PERCIVAL President 803-285-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery |
| 213ES0131X Podiatrist Foot Surgery | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-07-18 |