| NPI | 1902632664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY THOMAS Manager 623-512-1633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery |
| 213E00000X Podiatrist | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2024-09-10 |