Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003354101 |
---|---|
Provider Name | Farah Jean-Philippe |
First Address | Ruskin, FL 33570-7957 |
Second Address | Ruskin, FL 33570-7957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 08/02/2017 |