| NPI | 1407050123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE THESING Practice Administrator 843-853-3474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery Orthopaedic Trauma |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-08-22 |