Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA60117552 | WA |
NPI | 1750636213 |
---|---|
Provider Name | Mr. Wendell Mack Hombel I |
First Address | Deer Park, WA 99006-5008 |
Second Address | Deer Park, WA 99006-5008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 19/07/2012 |