Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2-1460 TX | TX |
NPI | 1073627725 |
---|---|
Provider Name | Dr. Kenneth R Waldman |
First Address | Pearland, TX 77584-2567 |
Second Address | Houston, TX 77074-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
742043057 | EMPLOYER ID (01) | TX |