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 |