Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT60314032 | WA |
NPI | 1013251552 |
---|---|
Provider Name | Irina Gordon |
First Address | Seattle, WA 98103-6745 |
Second Address | Seattle, WA 98103-6745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |