Individual
KRISTOFER KEDAR PETTWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 S NORMADE AVE APT 732, LOS ANGELES, CA 90020-3396
(516) 919-0061
Mailing address
411 S NORMADE AVE APT 732, LOS ANGELES, CA 90020-3396
(516) 919-0615
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
19393832
NY
Other
Enumeration date
07/23/2022
Last updated
07/23/2022
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