| NPI | 1851920029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL NISSEN Owner 860-282-4128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-11-19 |