| NPI | 1174928790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES F WETMORE Owner 203-893-5394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 002351) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2014-10-28 |