| NPI | 1487684346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KEITH WAGNER Owner 860-470-5703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000144) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-10-13 |