Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 2008-1002 | AK |
NPI | 1689827842 |
---|---|
Provider Name | Hisako Ito |
First Address | Fairbanks, AK 99701-4381 |
Second Address | Fairbanks, AK 99701-4381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2008 |
Last Update Date | 31/10/2008 |