Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0054 | NH |
N | 175F00000X | Naturopath | 695 | CT |
NPI | 1124783741 |
---|---|
Provider Name | Dr. Misharo C Fraser |
First Address | Bridgeport, CT 06606-1927 |
Second Address | Bridgeport, CT 06606-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 08/11/2021 |