Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000473 | CT |
N | 175F00000X | Naturopath | NT 60121435 | WA |
NPI | 1104154442 |
---|---|
Provider Name | Dr. Jason David Culp |
First Address | Southbury, CT 06488-2287 |
Second Address | Southbury, CT 06488-2287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 14/12/2011 |