Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | EXEMPT | NM |
NPI | 1659616787 |
---|---|
Provider Name | Mr. Tommy L Gardner |
First Address | Santa Fe, NM 87501-1868 |
Second Address | Santa Fe, NM 87507-9449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 24/05/2021 |