| NPI | 1861906703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN D HARNESS Owner 636-600-8011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2004024287) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2018-03-17 |