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 |