| NPI | 1922251107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER SHERLINE Business Manager 860-677-4539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 035147) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CT 035147) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2008-10-31 |