Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND884 | CA |
NPI | 1144752171 |
---|---|
Provider Name | Dr. Brian Haller Keenan |
First Address | San Luis Obispo, CA 93401-2937 |
Second Address | San Luis Obispo, CA 93401-2937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |