Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT 00000458 | WA |
NPI | 1013159128 |
---|---|
Provider Name | Dr. Andrew Lange |
First Address | Boulder, CO 80304-2516 |
Second Address | Boulder, CO 80304-2516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 03/04/2009 |