Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1104374263 |
---|---|
Provider Name | Aaron Deforest |
First Address | Petaluma, CA 94952-2349 |
Second Address | Petaluma, CA 94952-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 19/09/2016 |