Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1063717114 |
---|---|
Provider Name | Bryan Walsh |
First Address | Glen Burnie, MD 21060 |
Second Address | Ellicott City, MD 21042-4016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 21/01/2011 |