Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 903856 | AK |
NPI | 1205029642 |
---|---|
Provider Name | C Brett Connor |
First Address | Kotzebue, AK 99752-1246 |
Second Address | Kotzebue, AK 99752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |