| NPI | 1154308229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN R DIETRICH Partner Md 860-653-4526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2013-06-26 |