Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003300872 |
---|---|
Provider Name | David Stewart |
First Address | Saint Cloud, FL 34772-7779 |
Second Address | Saint Cloud, FL 34772-7779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 07/12/2020 |