| NPI | 1093952194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW J RAIDER Sole Proprietor 860-767-4024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 22948) |
| Enumeration Date | 2009-01-11 |
| Last Update Date | 2009-02-19 |