Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | FL | |
N | 106S00000X | Behavior Technician | FL |
NPI | 1154075844 |
---|---|
Provider Name | Asif Islam |
First Address | Deerfield Beach, FL 33441-1817 |
Second Address | Deerfield Beach, FL 33441-1817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |