Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003192683 |
---|---|
Provider Name | Mr. Rodger Twitchell |
First Address | Culver City, CA 90230-7068 |
Second Address | Culver City, CA 90230-7068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2011 |
Last Update Date | 27/10/2011 |