Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 1985 | SC |
Y | 175F00000X | Naturopath | MSG 000587 | PA |
NPI | 1063843662 |
---|---|
Provider Name | Robert Korb |
First Address | Mcmurray, PA 15317-3428 |
Second Address | Mc Murray, PA 15317-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2013 |
Last Update Date | 06/12/2013 |