| NPI | 1932856333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JASON ELLENBOGEN President 704-442-9011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| 213ES0131X Podiatrist, Foot Surgery | |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-02-14 |