| NPI | 1427799485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE J NELSEN Employee 607-215-5159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-06-07 |