Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2707 | CO |
Y | 103T00000X | Psychologist | 2707 | CO |
NPI | 1003028408 |
---|---|
Provider Name | Robert Brill |
First Address | Boulder, CO 80304-1031 |
Second Address | Westminster, CO 80003-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 08/07/2007 |