NPI | 1942405246 |
---|---|
Entity Type | Organization |
Authorized Contact | JODIE JACOBY Office Manager 860-673-1667 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: CT 016756) |
Additional Taxonomies | 174400000X Specialist (Licence: CT 022522) |
363A00000X Physician Assistant (Licence: CT 000178) | |
Enumeration Date | 2007-06-18 |
Last Update Date | 2020-08-22 |