| NPI | 1205378353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IAN TUCKER Medical Director/Owner/President 860-749-8887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |