| NPI | 1124112180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN B GOLUB Owner 602-402-0421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-03-26 |