| NPI | 1063472363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA GOURLIE Office Manager 860-873-8983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 024845) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000457) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-08-22 |