Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS007140L | PA |
Y | 103T00000X | Psychologist | PS007140L | PA |
NPI | 1013989367 |
---|---|
Provider Name | Dr. Domingo Luiggi |
First Address | Bala Cynwyd, PA 19004-1017 |
Second Address | Bala Cynwyd, PA 19004-1017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/07/2007 |