Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 17-1663 | AZ |
NPI | 1043720212 |
---|---|
Provider Name | Dr. Drew Willibrord Mackay-Timmermans |
First Address | Gilbert, AZ 85233 |
Second Address | Gilbert, AZ 85233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 30/05/2019 |