| NPI | 1790183028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ANDREW WEILAND President/CEO 605-212-5941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SD 179) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2023-05-08 |