| NPI | 1144537523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH E FATKIN Owner 702-435-7987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: NV 1008) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NV 1008) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2022-07-21 |