Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4289 | OR |
NPI | 1073143806 |
---|---|
Provider Name | Dr. Brett Allan Kingsley |
First Address | Portland, OR 97202-6034 |
Second Address | Portland, OR 97202-6034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 21/01/2020 |