Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY6445 | CA |
Y | 103T00000X | Psychologist | PY6445 | CA |
NPI | 1013065101 |
---|---|
Provider Name | Dr. James Oral Henman |
First Address | Modesto, CA 95354-2414 |
Second Address | Modesto, CA 95354-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |