| NPI | 1235918764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BRENES COO 203-598-6045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 208600000X Surgery |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-09-25 |