Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2471-057 | WI |
NPI | 1073695474 |
---|---|
Provider Name | Dr. Paul Robert Hamilton |
First Address | Menomonee Falls, WI 53051-3776 |
Second Address | Menomonee Falls, WI 53051-3776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43583000 | (05) | WI |