Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2802 | NC |
Y | 103TC0700X | Clinical Psychologist | 2802 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2802 | NC |
NPI | 1083668487 |
---|---|
Provider Name | Dr. Kurt D. Michael |
First Address | Boone, NC 28607-5067 |
Second Address | Boone, NC 28607-5067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 10/05/2011 |