Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT60065507 | WA |
NPI | 1033358551 |
---|---|
Provider Name | Dr. Samyar Stanislav Bukovcan |
First Address | Bellevue, WA 98004-3021 |
Second Address | Bellevue, WA 98004-3021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2009 |
Last Update Date | 05/02/2009 |