Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 03-772 | AZ |
NPI | 1104965318 |
---|---|
Provider Name | Jonathan Psenka |
First Address | Phoenix, AZ 85021-4105 |
Second Address | Phoenix, AZ 85032-5613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0944610 | (02) | AZ |