| NPI | 1629679923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRETT MICHAEL LEATHEM Md, Owner 860-670-2412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2021-01-20 |