Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2002002061 | MO |
NPI | 1003048265 |
---|---|
Provider Name | Dr. Gary Kulak |
First Address | Saint Louis, MO 63146-5567 |
Second Address | Saint Louis, MO 63146-5567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193400000X | RETIRED-PSYCHIATRIST (01) | MO |