Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000322 | CT |
NPI | 1124226956 |
---|---|
Provider Name | Richard Albert Seres |
First Address | Fairfield, CT 06824-5916 |
Second Address | Fairfield, CT 06824-5916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000322 | LICENSE NUMBER (01) | CT |