| NPI | 1316459787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE HAWKINS Credentialing Account Manager 210-298-6847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4380) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-10-25 |