Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2436 | KS |
Y | 103T00000X | Psychologist | 2436 | KS |
NPI | 1013462639 |
---|---|
Provider Name | Marcus Alt |
First Address | Kansas City, MO 64105-1680 |
Second Address | Kansas City, KS 66160-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2016 |
Last Update Date | 24/08/2016 |