| NPI | 1134009277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA DREW BOUSTANI Intern 860-808-4290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |