Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 099.0134073 | VT |
NPI | 1003384926 |
---|---|
Provider Name | Dr. Mikael Laursen Brucker |
First Address | Elkins Park, PA 19027-1417 |
Second Address | Elkins Park, PA 19027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 08/11/2018 |