| NPI | 1841851201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE POTTER Credentialing Manager 916-846-9454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2026-07-20 |