Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 049730 | CT |
NPI | 1003016270 |
---|---|
Provider Name | Dr. Vijai Brindaban Muthukrishnan |
First Address | Burlington, CT 06013-1323 |
Second Address | Bristol, CT 06010-3893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 20/04/2011 |