| NPI | 1043451214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SCOTT WARREN Member 860-521-4044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 042022) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2013-07-23 |