Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1217 | VA |
Y | 103TC0700X | Clinical Psychologist | 1217 | VA |
NPI | 1003907262 |
---|---|
Provider Name | Mr. Edward Michael Shumate |
First Address | Apo, AE 09244 |
Second Address | Apo, AE 09244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VADOOO | (02) |