| NPI | 1255521019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ETKIN Owner 230-932-3227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 000373) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |