| NPI | 1588446439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT MICHAEL LEATHEM Owner 860-670-2412 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 208VP0000X | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-10-16 |