Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1245635903 |
---|---|
Provider Name | Dr. Richard Kutz JR. |
First Address | Indiana, PA 15701 |
Second Address | Indiana, PA 15701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 23/10/2014 |