Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NAT - 62 | ID |
N | 175L00000X | Homeopath |
NPI | 1437231594 |
---|---|
Provider Name | Dr. Brent Burtis Mathieu |
First Address | Boise, ID 83703-4417 |
Second Address | Boise, ID 83703-4417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 18/04/2014 |