Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1556 | WI |
Y | 103T00000X | Psychologist | 1556 | WI |
NPI | 1013929108 |
---|---|
Provider Name | Dr. David Lee Smith |
First Address | Waukesha, WI 53188-1372 |
Second Address | Waukesha, WI 53188-2498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 08/07/2007 |