| NPI | 1952586000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JONATHAN FREDERIKS Member 860-510-0792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 036811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 042678) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-09 |