Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301012911 | MI |
Y | 103T00000X | Psychologist | 6301012911 | MI |
NPI | 1003867680 |
---|---|
Provider Name | Theodore Alan Sinnaeve |
First Address | Lansing, MI 48910-6818 |
Second Address | Lansing, MI 48911-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |