| NPI | 1346788114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ROBERT DUSHACK CEO 239-433-0064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3600) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3600) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-02-01 |