| NPI | 1679514186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN KENNETH AVERETT President 208-661-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID p177) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-07-21 |