Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 00061 | CT |
NPI | 1063408524 |
---|---|
Provider Name | Enrico Liva |
First Address | Middletown, CT 06457-2510 |
Second Address | Middletown, CT 06457-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/07/2007 |