Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OH1370197 | OH |
NPI | 1043634827 |
---|---|
Provider Name | Mr. Mark A. Bromley |
First Address | Clyde, OH 43410-1633 |
Second Address | Clyde, OH 43410-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2014 |
Last Update Date | 13/02/2014 |