Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 004705 | CT |
NPI | 1629259049 |
---|---|
Provider Name | Mr. Stephen B Callis |
First Address | Vernon, CT 06066-2045 |
Second Address | Vernon, CT 06066-3512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 14/11/2007 |