| NPI | 1982662201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTHANN PARK Practice Adminisrtator 239-433-0064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO1528) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-08-22 |