| NPI | 1780082214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BROADHEAD Owner 314-837-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2022-09-01 |