Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301012477 | MI |
NPI | 1104806850 |
---|---|
Provider Name | Andre' Pauritsch |
First Address | New Baltimore, MI 48047 |
Second Address | Utica, MI 48317-5716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |