Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1174067672 |
---|---|
Provider Name | Goldamedina Ross |
First Address | Oklahoma City, OK 73111-1929 |
Second Address | Oklahoma City, OK 73111-1929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 19/12/2016 |