| NPI | 1386996395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E WEAVER President 239-278-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO0001857) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2013-05-13 |