Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1134511322 |
---|---|
Provider Name | Mr. Mitchell Bradshaw |
First Address | San Diego, CA 92110-4906 |
Second Address | San Diego, CA 92110-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 24/02/2015 |