Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | LD-92 | ID |
NPI | 1174051403 |
---|---|
Provider Name | Josh Robert Westerberg |
First Address | Caldwell, ID 83605-4426 |
Second Address | Caldwell, ID 83605-4426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |