Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1275098600 |
---|---|
Provider Name | Cal Lawanson |
First Address | Kansas City, MO 64155-2091 |
Second Address | Kansas City, MO 64155-2091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2019 |
Last Update Date | 11/02/2019 |