Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND980 | CA |
NPI | 1144704545 |
---|---|
Provider Name | Dr. Ryan Charles Olson |
First Address | Sebastopol, CA 95472-3142 |
Second Address | Sebastopol, CA 95472-3142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |