| NPI | 1497141311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON M WILSON Owner 985-867-0301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA DPM.200036) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-07-23 |