Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1184075152 |
---|---|
Provider Name | Dr. Dr. Duane Frisby |
First Address | Wellington, FL 33414-8068 |
Second Address | Wellington, FL 33414-8068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 30/06/2016 |