Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 0690 | KS |
NPI | 1013999507 |
---|---|
Provider Name | Dr. Joseph R Hertzler |
First Address | Wichita, KS 67218-1607 |
Second Address | Wichita, KS 67218-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 30/04/2008 |