Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003323932 |
---|---|
Provider Name | Jean Jean Paul |
First Address | Orlando, FL 32836-8838 |
Second Address | Orlando, FL 32836-8838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2017 |
Last Update Date | 30/12/2017 |