Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2048 | AZ |
NPI | 1194850248 |
---|---|
Provider Name | Dr. David Ralph Engstrom |
First Address | Scottsdale, AZ 85258-4802 |
Second Address | Scottsdale, AZ 85258-1298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |