| NPI | 1356743207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN WILLIAM FULLEM Medical Doctor/Owner 203-241-2582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3445) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2015-01-07 |