Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 19-1814 | AZ |
NPI | 1033752340 |
---|---|
Provider Name | Dr. Houtaneh Houtan |
First Address | Mount Laurel, NJ 08054-2732 |
Second Address | Merchantville, NJ 08109-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2019 |
Last Update Date | 21/10/2019 |