Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MT.0017222 | CO |
NPI | 1558758094 |
---|---|
Provider Name | Mr. Tom Paul Fabish |
First Address | Denver, CO 80210-3801 |
Second Address | Denver, CO 80210-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 22/04/2015 |