Under California state law, NDs have a broad scope of practice and are licensed as primary care doctors. NDs can diagnose, order lab and imaging tests, and treat illness with natural therapies. NDs can also prescribe all unscheduled drugs from the pharmacy. All states and provinces with laws regulating the practice of naturopathic medicine require a resident course of at least four years of doctoral-level study from a college or university recognized by the Council on Naturopathic Medical Education (CNME). To qualify for a license, the applicant must satisfactorily pass the Naturopathic Physicians Licensing Examinations (NPLEX), which includes basic sciences, diagnostic and therapeutic subjects and clinical sciences. Currently, naturopathic doctors are licensed or registered as health care providers in Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, Wisconsin, and the U.S. territories of Puerto Rico and the Virgin Islands. Legal provisions allow the practice of naturopathic medicine in several other states. Naturopathic doctors are also recognized in Alberta, British Columbia, Manitoba, Ontario, Nova Scotia, the Northwest Territories, and Saskatchewan. Efforts to gain licensure elsewhere are currently under way. Additionally, professional associations exist in 42 states and 11 provinces.