| NPI | 1962874669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON S PERCIVAL Authorized Official 803-285-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 213ES0131X Podiatrist, Foot Surgery | |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |