Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0765 | OR |
NPI | 1043340508 |
---|---|
Provider Name | John Winters |
First Address | La Grande, OR 97850-2520 |
Second Address | La Grande, OR 97850-2520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |