Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY9143 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY9143 | CA |
NPI | 1003970310 |
---|---|
Provider Name | Dr. John Thomas Peters |
First Address | Redwood City, CA 94063 |
Second Address | Redwood City, CA 94063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |