| NPI | 1760540397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY J MARTIN Office Manager 860-889-3841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 016369) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 030790) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-08-02 |