| NPI | 1619694478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM RUSSO Principal 802-636-4133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 171100000X Acupuncturist |
| 175F00000X Naturopath | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2025-02-14 |