| NPI | 1457688020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EVANS GLASS Single Member Of LLC 203-500-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 044810) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2019-09-19 |