Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | GA |
NPI | 1063083624 |
---|---|
Provider Name | Benjamin Trad |
First Address | Richmond Hill, GA 31324-3948 |
Second Address | Richmond Hill, GA 31324-3948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |