| NPI | 1720489818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER K HAGAN Sole Member 252-633-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 617) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 617) |
| 213ES0131X (Licence: NC 617) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2014-12-04 |