| NPI | 1750730628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA HOLMES Owner 100-000-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103000695) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2016-06-28 |