Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2407-057 | WI |
Y | 103TC0700X | Clinical Psychologist | 2407-057 | WI |
NPI | 1003905704 |
---|---|
Provider Name | Dr. David C. Lee |
First Address | Madison, WI 53705-1005 |
Second Address | Madison, WI 53705-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 03/11/2016 |