Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 5.000540 | CT |
NPI | 1013393487 |
---|---|
Provider Name | Aylah Clark |
First Address | Avon, CT 06001-3793 |
Second Address | Avon, CT 06001-3793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2015 |
Last Update Date | 07/08/2015 |