Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 099.0091947 | VT |
NPI | 1144563438 |
---|---|
Provider Name | Dr. Thomas Mario Declemente |
First Address | Brattleboro, VT 05301-9705 |
Second Address | Brattleboro, VT 05301-9705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 04/04/2013 |