Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 7096 | NM |
NPI | 1912275298 |
---|---|
Provider Name | Mr. Daniel Taylor |
First Address | Las Cruces, NM 88011-8112 |
Second Address | Las Cruces, NM 88011-8112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2011 |
Last Update Date | 01/12/2011 |