Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6301008669 | MI |
N | 103TC0700X | Clinical Psychologist | 6301008669 | MI |
Y | 103TM1800X | Intellectual & Developmental Disabilities | 6301008669 | MI |
NPI | 1003901943 |
---|---|
Provider Name | John Robert Langlois |
First Address | Auburn Hills, MI 48326-2617 |
Second Address | Bloomfield Hills, MI 48302-0950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 11/04/2014 |