Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 629 | CT |
NPI | 1073098430 |
---|---|
Provider Name | Kali Olsen |
First Address | Baldwin, NY 11510-3728 |
Second Address | Hamden, CT 06518-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 02/10/2021 |