Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1722 | AZ |
NPI | 1003391152 |
---|---|
Provider Name | Dr. Mitchell Roodvoets |
First Address | Gilbert, AZ 85234-2689 |
Second Address | Gilbert, AZ 85234-2689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 18/10/2019 |