| NPI | 1598372666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTINA RANDALL President 267-934-6996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2023-04-26 |