Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS 410 | FL |
NPI | 1063680080 |
---|---|
Provider Name | Mr. Peter S. Larkin |
First Address | Palm Coast, FL 32137-9000 |
Second Address | Palm Coast, FL 32137-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 12/02/2008 |