Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 0461 | CT |
NPI | 1144222076 |
---|---|
Provider Name | Dr. David B. Dziura |
First Address | Branford, CT 06405-3613 |
Second Address | Branford, CT 06405-3613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 07/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T22992 | (02) | CT |