| NPI | 1740602515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HOWARD LAVALETTE Owner 860-657-5800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 037023) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 002159) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2014-01-14 |