Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003450297 |
---|---|
Provider Name | Dexter Davis |
First Address | Marlborough, MA 01752-5900 |
Second Address | Marlborough, MA 01752-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 31/10/2019 |