Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 5690 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 5690 | CA |
NPI | 1003033721 |
---|---|
Provider Name | Dennis Kent Unruh |
First Address | Fresno, CA 93711-0823 |
Second Address | Madera, CA 93638-5715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |