| NPI | 1790987428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBROSE K SU Owner 541-382-7521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OR DP00159) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OR DP00128) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2013-08-28 |