Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY7997 | FL |
Y | 103TC0700X | Clinical Psychologist | PY7997 | FL |
NPI | 1003142167 |
---|---|
Provider Name | Mathieu Kamburian |
First Address | Pembroke Pines, FL 33025-4554 |
Second Address | Pembroke Pines, FL 33025-4554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 26/10/2009 |