Individual
MICHAEL DISTASIO
Active
Individual
MICHAEL DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
154019
CT
363LF0000X
Family Nurse Practitioner
Primary
14094
CT
Other
Enumeration date
02/14/2024
Last updated
12/05/2024
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