| NPI | 1336327642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM PAUL LICANDRO Owner 563-441-0117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center Podiatric (Licence: IA 00705) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 00705) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2008-03-08 |