| NPI | 1225751068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GRYLKA Operations Manager 860-759-7774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2023-02-23 |