Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BA-91 | AZ |
NPI | 1013341395 |
---|---|
Provider Name | Dr. Jacob Boney |
First Address | Tempe, AZ 85282-2039 |
Second Address | Phoenix, AZ 85051-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2013 |
Last Update Date | 22/08/2013 |