Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1912364167 |
---|---|
Provider Name | Mr. Gary Ferguson |
First Address | Folsom, CA 95763-6466 |
Second Address | Folsom, CA 95630-6801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 19/01/2016 |