| NPI | 1073967022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMESON B NOORDA Manager 702-456-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2016-04-15 |