Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS482 | ME |
Y | 103TC0700X | Clinical Psychologist | PS482 | ME |
NPI | 1003034570 |
---|---|
Provider Name | Peter L Burgher |
First Address | Waterville, ME 04901-5905 |
Second Address | Waterville, ME 04901-5905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 21/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219530000 | (05) | ME |