Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 21679522 | OH |
NPI | 1083220982 |
---|---|
Provider Name | Christopher Enz |
First Address | Mc Dermott, OH 45652-9000 |
Second Address | Mc Dermott, OH 45652-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2020 |
Last Update Date | 17/09/2020 |