Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 13685 | TX |
NPI | 1528568961 |
---|---|
Provider Name | Dr. Wesley Ply |
First Address | San Marcos, TX 78666-2198 |
Second Address | New Braunfels, TX 78130-2162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 11/09/2018 |