Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH 60342432 | WA |
NPI | 1083050496 |
---|---|
Provider Name | Myron Gudmundson |
First Address | Woodinville, WA 98072-6876 |
Second Address | Woodinville, WA 98072-6876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 03/03/2014 |