| NPI | 1902155526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARIQUE DHYAN PERERA Owner 203-769-1312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 039232) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-03-28 |