Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 37 | NH |
NPI | 1124463237 |
---|---|
Provider Name | Douglas Jesse Mackay |
First Address | Washington, DC 20036-5104 |
Second Address | Washington, DC 20036-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2013 |
Last Update Date | 02/05/2013 |