| NPI | 1265931182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LEE Owner 860-269-4808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 000723) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 000723) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |