Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT60999155 | WA |
NPI | 1063053387 |
---|---|
Provider Name | Jonathan Bakker |
First Address | North Bend, WA 98045-0288 |
Second Address | Seattle, WA 98115-2023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 08/10/2019 |