Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 01-671 | AZ |
NPI | 1114145083 |
---|---|
Provider Name | Dr. Matthew Ivy Baral |
First Address | Tempe, AZ 85282-2655 |
Second Address | Scottsdale, AZ 85257-3867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |