Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1518234756 |
---|---|
Provider Name | David W Gwin |
First Address | Mcalester, OK 74501-5363 |
Second Address | Mcalester, OK 74501-5363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 16/11/2011 |