Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1621 | OR |
NPI | 1104070168 |
---|---|
Provider Name | Dr. Juniper Martin |
First Address | Tigard, OR 97223-6460 |
Second Address | Tigard, OR 97223-6460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 11/02/2010 |