| NPI | 1588918429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CHARLES MCDONALD Manager 704-786-4482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 443) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 443) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NC 443) | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2016-11-02 |