Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1265763247 |
---|---|
Provider Name | David Cosio |
First Address | Chicago, IL 60612-3728 |
Second Address | Chicago, IL 60612-3728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |