| NPI | 1073695888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE CULLEN Manager 781-444-7137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: MA 1693) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1693) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2012-10-30 |