Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1033647292 |
---|---|
Provider Name | Vidur Malik |
First Address | Fremont, CA 94555-1333 |
Second Address | Fremont, CA 94538-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |