Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 01022 | IA |
Y | 103T00000X | Psychologist | 01022 | IA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 000494 | IA |
NPI | 1063699668 |
---|---|
Provider Name | Todd Gabriel Kopelman |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 04/03/2008 |