Individual
LARRY IRA GILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 AUGUSTA DR, NEWINGTON, CT 06111-2502
(860) 666-5805
Mailing address
33 AUGUSTA DR, NEWINGTON, CT 06111-2502
(860) 666-5805
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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