Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1003113986 |
---|---|
Provider Name | Mr. Fred J. Popeski |
First Address | Fairview, PA 16415-2334 |
Second Address | Erie, PA 16506-4523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2011 |
Last Update Date | 11/02/2011 |