Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3985 | CO |
Y | 103T00000X | Psychologist | 3985 | CO |
NPI | 1003246497 |
---|---|
Provider Name | Dr. John Knorek |
First Address | Fpo, AP 96362-2899 |
Second Address | Fpo, AP 96362-9998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2013 |
Last Update Date | 20/11/2013 |