| NPI | 1902335102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL REYNOLDS Credentialing Supervisor 505-226-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 290) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-07-21 |