Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 698 | CA |
N | 175F00000X | Naturopath | NATU.NT.60505930 | WA |
N | 225700000X | Massage Therapist | MA 60297086 | WA |
NPI | 1124425434 |
---|---|
Provider Name | Dr. Nikodemas Simonas Mcnulty |
First Address | Encinitas, CA 92024-2474 |
Second Address | Encinitas, CA 92024-2474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 07/05/2016 |