Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC003891L | PA |
NPI | 1154565356 |
---|---|
Provider Name | Mark Frawley |
First Address | Coopersburg, PA 18036-9702 |
Second Address | Coopersburg, PA 18036-9702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2009 |
Last Update Date | 01/05/2009 |