| NPI | 1316501042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN JOHN DILLON Owner 203-215-7344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |