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Individual
MICHAEL MARK
Active
Individual
MICHAEL MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46-47-90333
FRANCHISE TAX BOARD
CA
Enumeration date
04/28/2015
Last updated
04/28/2015
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