Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1330 | OR |
NPI | 1093706186 |
---|---|
Provider Name | Dr. Paul Jeffrey Nicolai |
First Address | Portland, OR 97220-9056 |
Second Address | Portland, OR 97220-9056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2005 |
Last Update Date | 02/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275315 | OMAP (01) | OR |