| NPI | 1538504345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIYA BOYCE Regional Credentialing Specialist 301-933-7133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2025-08-07 |