| NPI | 1104905371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYEONG SHEARD President 336-282-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC NC233) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: NC 233) |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 233) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2009-01-05 |