Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | R0199 | MO |
NPI | 1104977552 |
---|---|
Provider Name | Hermann Carl Witte |
First Address | Saint Louis, MO 63110-1440 |
Second Address | Saint Louis, MO 63110-1440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2007 |
Last Update Date | 08/07/2007 |