| NPI | 1649221292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LINDBLOM Practice Administrator 203-318-5264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 17799) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-09-12 |