| NPI | 1154506400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON D LARSON Owner 732-899-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00100900) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2022-03-24 |