Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MAS-3004 | ID |
NPI | 1912440132 |
---|---|
Provider Name | Brian Leppert |
First Address | Post Falls, ID 83854-6282 |
Second Address | Post Falls, ID 83854-6282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2016 |
Last Update Date | 19/11/2016 |