Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS007695L | PA |
Y | 103TC0700X | Clinical Psychologist | PS007695L | PA |
NPI | 1003824194 |
---|---|
Provider Name | Dr. Edward Tindal Moon |
First Address | Philadelphia, PA 19103-6231 |
Second Address | Philadelphia, PA 19103-6231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 06/12/2016 |