| NPI | 1609647221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELSON LEACH Owner 203-571-3233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-04-24 |