Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003332404 |
---|---|
Provider Name | Davis Brigman |
First Address | Tinker Afb, OK 73145-8716 |
Second Address | Tinker Afb, OK 73145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 23/10/2019 |