Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3300-57 | WI |
Y | 103T00000X | Psychologist | 3300-57 | WI |
NPI | 1013385871 |
---|---|
Provider Name | Dr. David Baruch |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2015 |
Last Update Date | 10/09/2015 |