| NPI | 1558919134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY AINSWORTH IVESS Associate Director, Credentialing 571-366-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 261QP1100X Clinic/Center Podiatric |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |