Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301005434 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301005434 | MI |
NPI | 1003984907 |
---|---|
Provider Name | Diane Karle |
First Address | Royal Oak, MI 48073-1026 |
Second Address | Royal Oak, MI 48073-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R66734 | (02) |