Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1300X | Human Factors | 25977 | CA |
Y | 225XH1300X | Human Factors | 25977 | CA |
NPI | 1578802021 |
---|---|
Provider Name | Jason Marvin |
First Address | Woodland, CA 95776-6734 |
Second Address | Davis, CA 95616-4150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |