| NPI | 1710504048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JOHN DONATELLI Owner 304-487-9442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2020-08-11 |