Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY000389 | FL |
Y | 103T00000X | Psychologist | PY000389 | FL |
NPI | 1013064237 |
---|---|
Provider Name | Paul Bryan |
First Address | Palm Springs, FL 33461-2853 |
Second Address | Palm Springs, FL 33461-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 05/11/2009 |