Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 995 | OR |
NPI | 1023148186 |
---|---|
Provider Name | Kenneth Weizer |
First Address | Oregon City, OR 97045-8704 |
Second Address | Oregon City, OR 97045-8704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |