Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS002518-L | PA |
NPI | 1073728085 |
---|---|
Provider Name | Dr. Mark Edwin King |
First Address | Pittsburgh, PA 15213-3748 |
Second Address | Pittsburgh, PA 15213-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 08/07/2007 |