Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1013542950 |
---|---|
Provider Name | Mr. Bruce Andrew Kowal |
First Address | East Meadow, NY 11554-3901 |
Second Address | East Meadow, NY 11554-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2020 |
Last Update Date | 11/03/2020 |