| NPI | 1942218763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN W FULLEM Owner 203-426-7060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: CT 000556) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2010-03-09 |