Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 270198 | KY |
Y | 103TC0700X | Clinical Psychologist | 270198 | KY |
NPI | 1003489824 |
---|---|
Provider Name | Dr. Nicholas Bach |
First Address | Louisville, KY 40243-1010 |
Second Address | Louisville, KY 40243-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2021 |
Last Update Date | 20/07/2021 |