Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000155 | CT |
NPI | 1043464738 |
---|---|
Provider Name | Dr. Michael Mendribil |
First Address | Cos Cob, CT 06807-2734 |
Second Address | Cos Cob, CT 06807-2734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2008 |
Last Update Date | 12/03/2013 |