Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | CA |
NPI | 1104317403 |
---|---|
Provider Name | John Thomas Justin Gunton-Bell |
First Address | Sacramento, CA 95826-3231 |
Second Address | Sacramento, CA 95826-3231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 22/05/2018 |