Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY0516 | NV |
N | 103T00000X | Psychologist | PY0516 | NV |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY0516 | NV |
N | 103G00000X | Clinical Psychologist | PY0516 | NV |
N | 103TC0700X | Clinical Psychologist | PY0516 | NV |
N | 103TC1900X | Counseling Psychologist | PY0516 | NV |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY0516 | NV |
N | 103TF0000X | Family Psychologist | PY0516 | NV |
NPI | 1134337603 |
---|---|
Provider Name | Dr. Bradley W. Gruner |
First Address | North Las Vegas, NV 89030 |
Second Address | North Las Vegas, NV 89030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |