| NPI | 1821726464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR IDLIBI Provider 803-256-6776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 207ZM0300X Pathology Medical Microbiology |
| 207ZP0101X Pathology Anatomic Pathology | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |