Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | CA |
NPI | 1093198210 |
---|---|
Provider Name | Michael Gross |
First Address | Brooklyn, NY 11229-3901 |
Second Address | Brooklyn, NY 11229-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 07/07/2015 |