Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | ||
N | 156F00000X | Technician/Technologist |
NPI | 1043704943 |
---|---|
Provider Name | Charles Onyekachi Ozukwe JR. |
First Address | Okemos, MI 48864-2560 |
Second Address | Okemos, MI 48864-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 08/05/2020 |