Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 049238 | CT |
NPI | 1134411168 |
---|---|
Provider Name | Dennis Cooper Rau JR. |
First Address | Portland, CT 06480-1143 |
Second Address | Portland, CT 06480-1143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 10/05/2011 |