Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 612 | CO |
Y | 103TC0700X | Clinical Psychologist | 612 | CO |
NPI | 1003869694 |
---|---|
Provider Name | Dr. Marvin A Boeding |
First Address | Loveland, CO 80538-4292 |
Second Address | Loveland, CO 80538-4292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |