Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 01617 | AZ |
NPI | 1134347511 |
---|---|
Provider Name | Robert Gordon Milisen |
First Address | Tempe, AZ 85281-2090 |
Second Address | Tempe, AZ 85281-2090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |