Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1779 | OR |
NPI | 1013218502 |
---|---|
Provider Name | Dr. Michael Cory Grady |
First Address | Portland, OR 97219-5466 |
Second Address | Portland, OR 97219-5466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 22/12/2021 |