| NPI | 1659952133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON BULTSMA Owner/President 854-444-3129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2024-02-14 |