Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1043707623 |
---|---|
Provider Name | Mark Sherwood |
First Address | Broken Arrow, OK 74012-9016 |
Second Address | Tulsa, OK 74145-9212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |