Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1104101526 |
---|---|
Provider Name | Dr. Robert D Newman |
First Address | Wentzville, MO 63385-4822 |
Second Address | Wentzville, MO 63385-4822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 17/10/2011 |