Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 04388 | MD |
NPI | 1063627891 |
---|---|
Provider Name | Dr. Jonathan Dalton |
First Address | Olney, MD 20832-1769 |
Second Address | Silver Spring, MD 20901-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |