Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083252241 |
---|---|
Provider Name | Colby Holman |
First Address | Muskogee, OK 74403-8405 |
Second Address | Muskogee, OK 74401-6614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2019 |
Last Update Date | 18/12/2019 |