Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 83394 | DE |
NPI | 1003358300 |
---|---|
Provider Name | Sergio Oliva |
First Address | Wilmington, DE 19809-2306 |
Second Address | Wilmington, DE 19809-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 06/02/2017 |