Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1043819618 |
---|---|
Provider Name | Daniel Irvin Weller |
First Address | Menlo Park, CA 94025-1412 |
Second Address | Menlo Park, CA 94025-1412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2020 |
Last Update Date | 23/10/2020 |